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11 month old diagnosed with idiopathic central precocious puberty
Hi
My daughter is 11 months old around a month ago she developed breasts we took her to a ped endo, who ordered a bone age , her bone age came as 2 years . An ultrasound shows uterine volume of 1 cc and normal ovaries with no endometrium thickness, but a gnRh stimulation scared us the basal LH - 1.3 miu/ml and FSH - 40 miu/ml after the stimulation with gonadorelin 100 micrograms the values @ 30 mins were LH - 45.2 miu/ml and FSH - 149.1 miu/ml. An MRI without contrast was done and they say everything is fine .
My endo has diagnosed her with idiopathic CPP and wants to start the treatment , My concerns are should we really hurry up into the treatment? Is she too young to recieve the shots ? what would be the side effects of those monthly shots on this young child ? will she grow normally if we start the treatment ? how long can we wait before starting the treatment ? My husband is in US(Hartford CT) so you think we should get things evaluated there ?
I am really freaked at the thought of putting her on treatment and since she is so young i am concerned if she can still have idiopathic CPP (MRI says so but I am scared, my endo was suspecting a hypothalmic hamartoma)
And also the major concern is about the drugs availibility in india if i go to the US and start treament i am not sure if we will be able to continue the same here
Please help me
My daughter is 11 months old around a month ago she developed breasts we took her to a ped endo, who ordered a bone age , her bone age came as 2 years . An ultrasound shows uterine volume of 1 cc and normal ovaries with no endometrium thickness, but a gnRh stimulation scared us the basal LH - 1.3 miu/ml and FSH - 40 miu/ml after the stimulation with gonadorelin 100 micrograms the values @ 30 mins were LH - 45.2 miu/ml and FSH - 149.1 miu/ml. An MRI without contrast was done and they say everything is fine .
My endo has diagnosed her with idiopathic CPP and wants to start the treatment , My concerns are should we really hurry up into the treatment? Is she too young to recieve the shots ? what would be the side effects of those monthly shots on this young child ? will she grow normally if we start the treatment ? how long can we wait before starting the treatment ? My husband is in US(Hartford CT) so you think we should get things evaluated there ?
I am really freaked at the thought of putting her on treatment and since she is so young i am concerned if she can still have idiopathic CPP (MRI says so but I am scared, my endo was suspecting a hypothalmic hamartoma)
And also the major concern is about the drugs availibility in india if i go to the US and start treament i am not sure if we will be able to continue the same here
Please help me
MEDICAL PROFESSIONAL
Yes, the LH was high, above 6 is considered puberty level BUT the lh to fsh ratio is about 0.3, usually with early central puberty the lh is higher than that in comparison to the fsh, with a normal mri that is reassuring, ovaries are large and more than likely she will need treatment, but with her being so young I would consider another opinion,
If you go to Hartford, Yale has an amazing endocrine department, Scott Rivkees and his colleagues will take good care of you there, but realistically travelling from India to Connecticut needs to be considered with your husband, if you are going there anyway then when you travel set up a consultation, if you would only go for the second opinion then that may not be worth it.
They may want to be sure the mri was done with contrast and have someone read it again, or consider repeating the leuprolide stim test, need estrogen levels as well and 24 hour results.
If you go to Hartford, Yale has an amazing endocrine department, Scott Rivkees and his colleagues will take good care of you there, but realistically travelling from India to Connecticut needs to be considered with your husband, if you are going there anyway then when you travel set up a consultation, if you would only go for the second opinion then that may not be worth it.
They may want to be sure the mri was done with contrast and have someone read it again, or consider repeating the leuprolide stim test, need estrogen levels as well and 24 hour results.
A related discussion, Precocious Puberty was started.
MEDICAL PROFESSIONAL
Scott Rivkees and folks are at Yale, he is worth the wait, very smart guy, we tried to have him hired as our Chairman of Pediatrics, you are in good hands, nothing to do now, just wait its going to be ok especially since the mri was done and there is no brain tumor which is the most urgent cause. Hang in there.
I forgot to mention she has been growing in 50th percentile of her height , and a slightly above 50 percentile for weight .
Now she weighs 21.56 pounds and is 75cms tall , @birth she was 7.26 pounds and 50 cm and Neonatal TSH (ELISA) 0.23 miu/ml , 17 (OH) progesterone (Heel *****) 9.83 ng/mL.
Now she weighs 21.56 pounds and is 75cms tall , @birth she was 7.26 pounds and 50 cm and Neonatal TSH (ELISA) 0.23 miu/ml , 17 (OH) progesterone (Heel *****) 9.83 ng/mL.
Thanks Doctor
The ovarian volume was < 1cc , and uterine volume is 1cc .
We are trying to fix an appointment with the Yale guys , but looks like we might not get one before September.
Do you think we have that much time to start the treatment ? My endo in india said her vagina was pink and does not have the effect of estrogen, her basal estroidal was 5 which is prepubertal .
This is the reason I am confused , she has the estroidal as pre pubertal , they say an uterine volume of 1cc is ok pre pubertal , ovaries are < 1cc , with few folicles .
the only issue is advanced bone age by 1 year (she has a bone age of 2 years) and LH and FSH levels , do you think we can wait till september to begin her on treatment , please advise me , in this case i would go to join my husband .
She has no pubic hair or axillary hair no body ordour , her corpus to cervix rartio is 1:1.5
Thanks for the response please advise me on the waiting time
The ovarian volume was < 1cc , and uterine volume is 1cc .
We are trying to fix an appointment with the Yale guys , but looks like we might not get one before September.
Do you think we have that much time to start the treatment ? My endo in india said her vagina was pink and does not have the effect of estrogen, her basal estroidal was 5 which is prepubertal .
This is the reason I am confused , she has the estroidal as pre pubertal , they say an uterine volume of 1cc is ok pre pubertal , ovaries are < 1cc , with few folicles .
the only issue is advanced bone age by 1 year (she has a bone age of 2 years) and LH and FSH levels , do you think we can wait till september to begin her on treatment , please advise me , in this case i would go to join my husband .
She has no pubic hair or axillary hair no body ordour , her corpus to cervix rartio is 1:1.5
Thanks for the response please advise me on the waiting time
Doctor
Could you please help me I am really confused and need help
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